What are the best ways to prevent a urinary tract infection?

While urinary tract infections are not always entirely avoidable, there are a few measures that can be taken to help prevent them as far as possible.

General UTI prevention tips

• Remain adequately hydrated on a daily basis to promote healthy and regular urination patterns.
• Maintain sound hygiene habits – females especially should always wipe from front to back following urination or a bowel movement, and not the other way around to avoid bacterial contamination. Males should also wipe in this direction following a bowel movement.
• Urinate as soon as possible when the urge arises to avoid any presence of bacteria lingering for too long in the urinary tract and leading to organism proliferation (infection).
• Urinate before and after sexual activity – this flushes out any acquired bacteria.
• Wearing cotton underwear and loose-fitting clothing items can help to keep the urethra dry, preventing an environment prone to pathogen proliferation. Nylon fabrics may promote bacterial growth.
• Some birth control methods such as diaphragms, spermicides and unlubricated condoms can result in frequent or recurring UTIs. Alternative contraception methods can be used to prevent regular infections.
• Women should refrain from using hygiene sprays, soaps and douches in the vaginal area which can result in irritation and promote bacterial proliferation.

Preventing UTIs in children

Prevention by means of antibiotic treatment

Antibiotic prophylaxis (or suppressive antibacterial therapy) may be recommended by a treating physician, particularly for children suffering from UTIs. Symptomatic infections can benefit from preventative pharmacological care, taking into consideration antibiotic resistance at the time of treatment. Certain strains of bacteria do tend to become resistant to certain drugs – a doctor will always factor this into prescribed recommendations so as to ensure careful treatment management and effective eradication of organisms causing infection.

It is not always necessary for a child to be recommended preventative treatment, particularly with the intention to prevent uncomplicated recurrences. Unnecessary use of antibiotics can alter the resident flora of the gastrointestinal tract and interfere with the natural processes of healthy bacteria. Recurrent antibiotic use can then render the drug ineffective (i.e. not able to combat bacterial growth) in future.

Generally, preventative care is recommended for infections that are accompanied by vesicoureteral reflux (the backward flow of urine from the bladder into the kidneys).

Male infants and circumcision

A topic of many a research study, the effects of circumcision in male infants has been reasonably well analysed in terms of UTIs and risk of recurring infections. In general, circumcision is regarded as a possible preventative measure when it comes to UTIs, with circumcised infants not experiencing infection as frequently as their uncircumcised counterparts, including those that are born prematurely. One study found that uncircumcised premature infants appeared to have an increased risk for UTI compared with those who underwent the procedure. ⁽¹⁵⁾

General tips as they apply to children include:

• Changing the nappies / diapers of babies frequently through the day and encouraging frequent urination in young children. The genital area of babies and young children should be well cleaned daily. The use of gentle cleansers on these sensitive skin areas should help to prevent irritation as well as prevent bacterial growth. Older children can be taught and encouraged to practice good hygiene habits in this regard.
• Parents and caregivers should be mindful of constipation in babies and young children and encourage healthy and regular bowel movements wherever possible. Hard stools tend to press against the urinary tract and hinder the normal flow of urine. The more urine with bacterial organisms that remains in the bladder for extended periods of time, the more at risk of infection a child becomes.
• Any bladder-related problems or difficulties which arise in young children should be medically assessed and treated as soon as possible. Issues with bladder emptying may arise as a result of impaired muscle function (a bladder may then become overactive or underactive). Treatment (medical and behavioural adjustments) can potentially prevent infections. Many young children typically grow out of such problems as they get older.
• Urinary tract blockages, vesicoureteral reflux, and anatomical problems must be assessed by a urologist as soon as identified so that adequate treatment can be implemented, and likely recurrent infections prevented. Medical conditions, like diabetes and sickle cell anaemia (or disease) may be more prone to recurrent infections, thus regular medical check-ups can help to ensure that infections are kept at bay wherever possible with preventive treatment (as and when necessary).

Female UTI prevention 

Antibiotics for prevention

Women with recurrent UTIs may also benefit from antibiotic prophylaxis (or suppressive antibacterial therapy), along with some behavioural modifications (as may be appropriate). Should a woman appear to frequently experience urinary tract infection recurrence following sexual activity, antimicrobial medications may be recommended as a post-coital prophylaxis (prevention treatment). 

If such measures are taken by both doctor and patient, a physician will ensure to periodically monitor any signs of drug resistance. A doctor may consider more long-term medication use for recurrent complicated infections that involve the administration of multiple daily dosages where applicable. Within 6 months of continued use however, a break will be recommended. Medication use may then be resumed if infection recurs.

Post-menopausal women and recurring UTIs

Oestrogen replacement medications may be useful for post-menopausal women prone to frequent urinary tract infections. A vaginal cream containing estriol (applied nightly for 2 weeks, initially and followed by twice weekly applications for 8 months thereafter) can help to significantly reduce the frequency of recurrent UTIs.

Estriol is thought to help restore levels of lactobacilli (a gram-positive bacterium, which is regarded as ‘friendly’ or healthy and doesn’t typically cause infection or disease) normally found in the digestive, urinary and genital tracts, as well as decrease vaginal pH levels.

UTI prevention tips for pregnant women

• Avoid long warm water soaks in the bath which can stimulate bacterial growth.
• Be mindful to clean the urethral meatus (the external urethral orifice where urine exits the body) first when showering or bathing.
• Make use of (clean) washcloths to regularly clean the perineum (the area between the vulva / vagina and anus).
• Wash your hands before and after using the toilet – some may prefer liquid soaps as opposed to bar soaps so as to avoid exposure to potentially lingering bacteria on the product.
• Be mindful to always wipe from front to back after urinating or having a bowel movement.

Male UTI prevention

• The use of pre-operative antibiotics may help to reduce risk or prevent complications like bacteriuria (blood in the urine) should a male patient require surgical treatment (such as transurethral or laser prostatectomy, a transrectal prostate biopsy or a cystoscopy). Fluoroquinolone medications may be used in a preventative capacity.
• Behavioural changes concerning sexual activity – men can make use of condoms for better protection against STDs, as well as to reduce risk of urethritis.

Prevention considerations for specific populations

Those with spinal cord injuries and recurrent UTIs

The frequency of recurrent infections can be reduced with…

• Carefully monitored preventative antibiotic therapy - trimethoprim-sulfamethoxazole and nitrofurantoin (often alternated with doses of methenamine which converts to formic acid, helping to prevent bacterial growth in urine).
• Intermittent catheterisation

People requiring catheterisation

• Carefully monitored preventative antibiotic therapy – Medications can be given for several days following the removal of a catheter to prevent the likelihood of infection (especially in patients with compromised immune systems).
• CAUTI – this refers to UTIs as a result of indwelling catheters for extended periods (longer than 2 weeks at a time). Frequent replacements, as necessary, can help to reduce the risk of catheter-associated infections. Women, seniors and patients with compromised immune systems in particular, may be at higher risk for CAUTI. Thus, the required duration usage of catheters will be kept to as minimal a period as possible (i.e. catheters will be kept in place only for as long as is needed in order to achieve the relief of a bladder outlet obstruction). Catheters are recommended to be removed from post-operative patients as soon as possible and are not used commonly in elderly patients with incontinence (specifically in nursing homes) so as to avoid the risk of UTIs.
• Suprapubic catheters may be used to reduce the risk of development of a UTI (these catheters are inserted into the bladder via an incision made just below the navel / belly button).
• Condom catheters may be used to reduce the risk of bacteriuria in male patients. These catheters are often used in incontinent males and are attached to catheter bags which collect urine. These are placed on the penis in a similar way to condoms used for contraceptive / safe sexual activity purposes.
• Catheters coated in silver alloy (or silver oxide) may alleviate the risk of developing CAUTI.
• The hygiene habits of those handling catheters is important – handwashing before and after handling a catheter is an essential practice that must be adhered to in order to avoid bacterial contamination.

UTIs in kidney transplant patients

One complication associated with kidney transplants within the initial few months following the procedure is a UTI. Preventative measures usually entail antibiotic treatment in the days following surgery, with continued dosages between 4 and 8 months thereafter.

Reference:

^{15. US National Library of Medicine - National Institutes of Health. December 2000 Can circumcision prevent recurrent urinary tract infections in hospitalized infants?: https://www.ncbi.nlm.nih.gov/pubmed/11156067 [Accessed 28.03.2018]}